Thomas F, Clemmer T P, Larsen K G, Menlove R L, Orme J F, Christison E A
Department of Life Flight, LDS Hospital, Salt Lake City, UT 84143.
J Trauma. 1988 Apr;28(4):446-52. doi: 10.1097/00005373-198804000-00005.
This study assessed the injury severity, patient outcome, the cost of care, and the economic impact of Medicare DRG payment policies on patients referred to a Level I trauma center. Only 11 of 283 admitted traumatized patients were Medicare patients. Yet, these 11 Medicare patients left the trauma center with a deficit of $249,601. No significant differences were found between the Medicare and non-Medicare groups for Trauma Score, CRAMS Score, Glasgow Coma Score, Injury Severity Score, ICU or hospital length of stay, disability, or mortality. Under DRG's, Medicare payments ($4,237 +/- 2,351/patient) have fallen to 20% of prior cost-based Medicare reimbursements ($21,542 +/- 34,170/patient), are providing only 16% of hospital costs ($26,928 +/- 42,713/patient), and are significantly (p less than 0.0001) less than non-Medicare reimbursements ($15,288 +/- 17,111/patient). Despite the high financial losses occurring when the trauma center treats referred traumatized Medicare patients, when all referred Medicare and non-Medicare patient trauma reimbursements are combined, overall trauma revenues have declined by only 4.3% under DRG's. If Medicare DRG payments were to be adopted by all third-party payers, reimbursement ($5,058 +/- 4,090/patient) would be significantly (p less than 0.0001) less than current hospital reimbursements ($14,801 +/- 16,537/patient) and costs ($16,121 +/- 17,624/patient). These results indicate that although high financial losses result when caring for traumatized Medicare patients, DRG's have not had a major financial effect upon centers receiving referred trauma patients because of the low numbers of admitted traumatized Medicare patients. However, if third-party payers were to enact the Medicare payment system, devastating economic losses would be inflicted upon major trauma centers.
本研究评估了创伤严重程度、患者预后、护理成本以及医疗保险诊断相关分组（DRG）支付政策对转诊至一级创伤中心患者的经济影响。在283名入院的创伤患者中，只有11名是医疗保险患者。然而，这11名医疗保险患者离开创伤中心时出现了249,601美元的亏损。在创伤评分、CRAMS评分、格拉斯哥昏迷评分、损伤严重程度评分、重症监护病房（ICU）或住院时间、残疾或死亡率方面，医疗保险组和非医疗保险组之间未发现显著差异。在DRG支付方式下，医疗保险支付（每位患者4,237±2,351美元）已降至先前基于成本的医疗保险报销金额（每位患者21,542±34,170美元）的20%，仅能支付医院成本（每位患者26,928±42,713美元）的16%，且显著低于非医疗保险报销金额（每位患者15,288±17,111美元）（p<0.0001）。尽管创伤中心治疗转诊的创伤医疗保险患者时会出现高额财务损失，但当将所有转诊的医疗保险和非医疗保险患者的创伤报销费用合并计算时，在DRG支付方式下，总体创伤收入仅下降了4.3%。如果所有第三方支付者都采用医疗保险DRG支付方式，报销金额（每位患者5,058±4,090美元）将显著低于当前医院报销金额（每位患者14,801±16,537美元）和成本（每位患者16,121±17,624美元）（p<0.0001）。这些结果表明，尽管护理创伤医疗保险患者会导致高额财务损失，但由于入院的创伤医疗保险患者数量较少，DRG支付方式对接收转诊创伤患者的中心并未产生重大财务影响。然而，如果第三方支付者采用医疗保险支付系统，主要创伤中心将遭受毁灭性的经济损失。
